How to Keep Medicaid Under the 80 Hour Work Rule

A letter arrived saying Medicaid now needs proof of work hours. The wrong assumption is that a job or a class is already on file, or that the rule waits until January. Nebraska started on May 1, 2026, Montana on July 1, and every other expansion state must be running it by January 1, 2027. What ends coverage is not the rule itself but a 30 day notice that goes unanswered.

Check whether the rule applies to you

The federal rule, as of September 2026, covers adults aged 19 through 64 in the Medicaid expansion group who are not pregnant and not on Medicare. Children, people on disability Medicaid, and anyone over 64 are outside it. Your notice names the program you are in; if it says expansion, adult group, or your state's brand name for it, read on.

Run the exemption list before you count a single hour

The federal list excuses a parent or caretaker of a child under 14, a caregiver of a disabled family member, anyone medically frail, pregnant and postpartum members, former foster youth, American Indians and Alaska Natives, veterans with a total disability rating, people in substance use treatment, and anyone already meeting a SNAP or TANF work rule. Montana adds that the exemption is claimed on its Community Engagement Exclusions Form, called Appendix B, at application and again at each redetermination. Exemptions are not automatic; the form is what records them.

Count the hours or the income, whichever you can prove

The bar is 80 hours in a month of paid work, community service, or an approved work program, or school at least half time, or any mix that reaches 80. Income of at least 580 dollars in the month, which is 80 hours at the federal minimum wage, also clears it with no hour count at all. Montana counts 6 credit hours as half time and converts each credit to 13 engagement hours.

Find out what your state already knows

States must check wage and enrollment data first and ask you for paperwork only when the match fails. Nebraska says a member hears from the state only if verification cannot be completed. A new applicant has to show one qualifying month before the month of the application; an existing member has to show one or more months between renewals, so the payslip you need may be from months ago. Keep pay stubs, a school enrollment letter, or a signed volunteer log for every month you rely on.

Report on your state's form, not in a phone call

Montana takes its Community Engagement Activity Requirements Reporting Form, Appendix A, online through the portal linked from its Medicaid changes page, by mail to its Human and Community Services Division, in person at an Office of Public Assistance, or with help from the Public Assistance Helpline on 1-888-706-1535. Other states publish the same shape of form under their own name; the notice tells you which portal.

Answer the noncompliance notice inside 30 days

If the state decides you fell short, it must send a notice of noncompliance and give you 30 calendar days to show hours, income, or an exemption. Miss the 30 days and an application is denied or coverage ends. You can reapply at any time, but the gap in coverage is real and a hospital bill inside it is yours.

If coverage has already ended. The closing letter, which Montana calls a Notice of Adverse Action, carries the appeal instructions and the deadline. Appeal by the date printed on it and reapply in parallel; the two do not cancel each other.

If you also get SNAP. Meeting the SNAP 80 hour rule counts as meeting this one, and the same pay stubs serve both files.

Sources. CMS fact sheet on the Medicaid community engagement interim final rule, Montana DPHHS Medicaid changes, Montana DPHHS work requirement FAQs, Nebraska governor's announcement of Medicaid work requirements.